1106 - Persistent seroma after intrathecal baclofen pump replacement

Case Diagnosis: A 27-year-old male with spastic quadriplegic cerebral palsy with intrathecal baclofen pump and persistent seroma

Case Description: A 27-year-old male with spastic quadriplegic cerebral palsy with spasticity managed with intrathecal baclofen (ITB) pump was followed in pediatric rehab clinic. ITB pump was initially placed at age 12 with good control of spasticity. Pump was switched from 40 ml to 20 ml-size in September 2022, with medication Gablofen 2000 mcb/ml continued. Four months after replacement, he was evaluated by neurosurgery for swelling over the pump, consistent with postoperative seroma. No intervention was performed.

On his subsequent pump refill on May 2023, he was noted to have persistent seroma causing local discomfort. Exam was notable for palpable fluctuance overlying the pump, with skin intact, non-erythematous, and non-tender. 44.0 ml of serosanguinous fluid was aspirated from seroma and pump was successfully refilled. He demonstrated seroma recurrence on subsequent pump refill on August 2023, for which 44.0 ml was aspirated again. ITB pump remained functioning and spasticity well-controlled throughout this period.

Discussions:
Seroma is a known complication of ITB pump with incidence ranging from 3 to 16%. Fluid collects in the subcutaneous pockets surrounding the pump. Seroma is often seen in the early postoperative period with expected gradual absorption within 1-3 weeks. There are documented cases of seromas persisting for months which may become a source of infection, skin irritation and local discomfort, and potentially contribute to pump malfunction. Some cases show seromas regressed only after removal of the pump.

Conclusions: Persistent seroma after ITB pump should be closely monitored for symptoms of infection and local irritation, and to ensure it does not affect pump function.